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Metachronous gastric neoplasm beyond 5 years after endoscopic resection for early gastric cancer

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Abstract

Background and Aims

The natural course of early gastric cancer (EGC) following endoscopic submucosal dissection (ESD) remains unclear. This study aimed to clarify the long-term clinical outcomes and risk factors of metachronous gastric neoplasm (MGN) 5 years after ESD for EGC.

Methods

We performed a retrospective analysis of patients who underwent ESD for EGC from July 2005 to October 2015 in Seoul National University Hospital. Long-term clinical outcomes and risk factors of MGN after 5 years post-ESD were evaluated.

Results

Among the 2059 patients who underwent ESD for EGC, 1102 were followed up for > 5 years. MGN developed in 132 patients 5 years after ESD. During the median follow-up period of 85 months, the cumulative incidences of MGN and metachronous gastric cancer were 11.7, 16.9, and 27.0 and 7.6, 10.8, and 18.7% after 5, 7, and 10 years, respectively. In multivariable analysis, male sex (odds ratio 1.770; P = 0.042), severe intestinal metaplasia (odds ratio 1.255; P = 0.000), tumor-positive lateral margin (odds ratio 2.711; P = 0.008), < 5 mm lateral safety margin (odds ratio 1.568; P = 0.050), and synchronous adenoma (odds ratio 2.612; P = 0.001) were positive predictive factors, and successful eradication of Helicobacter pylori (odds ratio 0.514; P = 0.024) was a negative predictive factor for MGN after 5 years post-ESD.

Conclusion

The cumulative MGN incidence was high even 5 years post-ESD for EGC. Meticulous long-term endoscopic follow-up is mandatory, especially in male patients with underlying intestinal metaplasia, tumor-positive lateral margins, lateral safety margins of < 5 mm, and synchronous adenomas.

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Acknowledgements

This study was supported by a grant from the Liver Research Institute, Seoul National University College of Medicine. We would like to thank Editage (www.editage.co.kr) for English language editing.

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Authors and Affiliations

  1. Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Daehangno 101, Jongno-Gu, Seoul, 03080, South Korea

    Eunwoo Lee, Sang Gyun Kim, Bokyung Kim, Jue Lie Kim, Jung Kim, Hyunsoo Chung & Soo-Jeong Cho

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Correspondence to Sang Gyun Kim.

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Drs. Eunwoo Lee, Sang Gyun Kim, Bokyung Kim, Jue Lie Kim, Jung Kim, Hyunsoo Chung and Soo-Jeong Cho have no conflicts of interest or financial ties to disclose.

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Lee, E., Kim, S.G., Kim, B. et al. Metachronous gastric neoplasm beyond 5 years after endoscopic resection for early gastric cancer. Surg Endosc 37, 3901–3910 (2023). https://doi.org/10.1007/s00464-023-09889-9

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